Alabama Fixin' To Throw Thousands Of Kids Off Medicaid For Their Own Good

Workin' in the Rat Mine

Now that "Work Requirements" for basic safety net services are all the rage, Alabama wants in on the fun with a proposal to impose them on low-income parents of kids receiving Medicaid. As we noted when the Trump administration first opened the door to Medicaid work requirements, the dishonest rationale here is that Medicaid expansion has allowed some lazy non-disabled taker adults to qualify for Medicaid, so let's make them earn their keep. Even though most people on Medicaid already work at least part time, are disabled, or are in families where at least one member is employed.

Dubious though work requirements already are in states which expanded Medicaid under the ACA, Alabama's proposal is especially insane, since the state didn't expand Medicaid, and already excludes childless non-disabled adults from eligibility. Those welfare layabouts the Trump plan imagined are quite simply nonexistent under Alabama's Medicaid system, which already has the nation's most restrictive Medicaid eligibility rules. So who'll be forced to go get shitty make-work jobs or lose their meager benefits? Parents who are already barely getting by. Jesse Cross-Call, a senior policy analyst at the Center on Budget and Policy Priorities, explains just how ugly Alabama's proposal is:

Alabama proposes to require parents with Medicaid to spend at least 35 hours per week (or 20 hours if they have children under age 6) on “employment-related activities” such as work, job training, or job search to maintain their Medicaid coverage. It also proposes to shorten eligibility for what’s known as Transitional Medical Assistance (TMA), as explained below, from 12 months to six. These changes will cause a 20 percent drop in Medicaid enrollment for parents beginning next year, according to the state’s own estimates [...]

[C]utting TMA eligibility from 12 months to six would further limit coverage options for low-income parents. TMA provides up to a year of Medicaid coverage to parents who lose Medicaid due to increased earnings. At the same time that Alabama seeks to require parents to work, it would roll back a program that encourages work by reducing incentives for families on Medicaid to avoid finding a job or forgoing a raise because that would mean losing their Medicaid.

That's one fifth of Medicaid recipients getting booted from an already stingy system that has seen huge cuts in other services to people who should qualify for help. The insane factor here is the beautiful Catch-22: To qualify for Alabama's microscopic Medicaid benefits, dirt-poor people will be forced to work, and maybe the state will help them find a job, maybe not. If they don't find work, they'll be kicked off the program. If they do find work, the few extra dollars they bring in will -- TA-DAA! -- make them too rich to qualify for Medicaid anymore.

That's one hell of a catch, as they say.

A similar work requirement for Temporary Assistance to Needy Families (TANF) was devastating to the poor:

In Alabama, parents’ inability to comply with TANF’s strict work requirements is one big reason why the state’s caseload has declined so much: in 2016, the state’s program reached only 10 families out of every hundred in poverty, down from 17 in 2006 and 32 in 1996.

All those folks didn't get jobs and become self-sufficient; they just got poorer and fell off the radar. But if they're not getting benefits, obviously they're no longer bleeding the taxpayer dry, hurrah! You've probably noticed how everyone talks about Alabama as a nexus of prosperity, haven't you?

Oh, but it gets even better: You see, the wise people who've designed this scheme say it's all for the good of the parents who receive Medicaid now, since it's designed to "transition people to other health insurance." How noble! Except that the low-wage jobs most Medicaid recipients are likely to be able to find don't offer insurance. Further, since Alabama didn't expand Medicaid eligibility to start with, those whose new extra income disqualifies them for Medicaid will fall into the gap between Medicaid eligibility and the income needed to qualify for subsidized insurance on the ACA exchanges. But if they all become investment bankers, they'll be just fine.

Like some kind of soy-boy liberal policy analyst, Cross-Call points to research in states that expanded Medicaid, like Ohio and Michigan, that shows having reliable basic health insurance gave people improved prospects for finding and keeping jobs.

And adults in Medicaid expansion states have fewer debts sent to third-party collection agencies than adults in similar non-expansion states. If Alabama were serious about supporting work, it would drop its waiver proposal and join the 32 states (and Washington, D.C.) that have expanded Medicaid.

Which is all well and good, but let's not get all crazy here -- why would Alabama want to copy a couple of goddamn Yankee states that probably don't even shame their poors like the Bible says to? Ohio has that liberal RINO John Kasich, and Michigan is full of Muslim jihadist no-go zones, so no thank you, Mister Liberal so-called "expert," Alabama's gonna put those lazy poors to work for their children's medicine. The real solution to getting people off welfare isn't to help them become self sufficient. Obviously, it's to widen the cracks so more people fall into 'em.

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[ Center on Budget and Policy Priorities ]